For people with Crohn's disease, Humira may be effective if Remicade no longer helps, new research shows.
"We are very encouraged by the findings of this study and look forward to larger prospective studies," says researcher Konstantinos A. Papadakis, MD, with the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center in Los Angeles, in a news release. His paper appears in the current issue of American Journal of Gastroenterology.
Crohn's disease Crohn's disease is a serious chronic and inflammatory disease of the intestinal tract, causing diarrhea, cramping, stomach pain, weight loss, and in some cases rectal bleeding. These symptoms wax and wane, with periods of active inflammation and disease followed by periods of inactivity. There is no cure for Crohn's disease, but Remicade has helped to greatly reduce symptoms of this lifelong disease.
Remicade, a drug that works by blocking a part of the immune system know as TNF, is currently the only FDA-approved "biologic" treatment of this kind for the treatment of Crohn's disease. The drug lessens the symptom flare-ups and helps keep people in remission for long periods of time. It also helps people avoid developing fistulasfistulas, a common complication in people with Crohn's disease. Fistulas are openings of the intestine into other organs or on to the skin, such as around the anus -- which can seriously affect quality of life, and often requires surgery.
Crohn's Disease vs. Humira
In his study, Papadakis tested Humira, a similar drug that suppresses the immune system and is FDA-approved for treatment of rheumatoid arthritis.
His study involved 13 patients with Crohn's disease. All had been taking Remicade, but were no longer getting any relief from it. In the six-month study, they got an initial 80-milligram injection of Humira, then 40-milligram injections every two weeks. Researchers tracked their symptom relief.
Of the 13 patients, seven had complete symptom relief, four had partial relief, and two got no relief. Six of the patients required a boost in their dosage to maintain symptom relief.
Almost three quarters of the patients (73%) were able to discontinue or significantly decrease their concurrent dose of steroids.
All patients tolerated Humira without any allergic reactions; two patients had a skin reaction at the injection site.
Overall, the study shows that Humira is a strong option for Crohn's disease patients -- when Remicade no longer works, writes Papadakis.
Remicade's side effects include:
A rare but deadly liver reaction
Serious, even fatal, infections like tuberculosis
Increased risk of certain types of cancer like lymphoma
Increased risk of an autoimmune disorder such as a lupus-like syndrome
Humira's side effects include:
Serious, even fatal, infections like tuberculosis
Increased risk of certain types of cancer, like lymphoma
Increased risk of an autoimmune disorder such as a lupus-like syndrome
Showing posts with label tuberculosis and crohn's disease. Show all posts
Showing posts with label tuberculosis and crohn's disease. Show all posts
Wednesday, February 13, 2008
Sunday, December 2, 2007
Scott Roy in the Orlando Sentinel - Crohn's Article with Dr. Shafran
Link to the article is here - http://www.orlandosentinel.com/community/news/deltona/orl-crohns0207dec02,0,4333743.story
Dr. Shafran (Winter Park, FL) was featured in the Orlando Sentinel today for an article highlighting his Crohn's Disease Research. He just published a paper on a new antibiotic used to treat Crohn's, and the relation to bacteria and Crohn's Disease. Yours truly, Mr Scott Roy, is featured in the lead photo. I love the way Dr. Shafran and his staff take care of me!! He is an awesome doctor. I encourage you all to check out the article, and if you are in Florida, you will not find a better Gastroenterologist.
Dr. Shafran (Winter Park, FL) was featured in the Orlando Sentinel today for an article highlighting his Crohn's Disease Research. He just published a paper on a new antibiotic used to treat Crohn's, and the relation to bacteria and Crohn's Disease. Yours truly, Mr Scott Roy, is featured in the lead photo. I love the way Dr. Shafran and his staff take care of me!! He is an awesome doctor. I encourage you all to check out the article, and if you are in Florida, you will not find a better Gastroenterologist.
Here is the article:
Dr. Ira Shafran sees Crohn's disease patient Scott Roy at his Winter Park office. Shafran is a gastroenterologist who is treating some Crohn's disease patients with antibiotics. (ROBERTO GONZALEZ, ORLANDO SENTINEL / November 21, 2007)
Doctors are trying a new strategy to treat Crohn's disease, an often-debilitating digestive condition that typically strikes in the teens or 20s and causes lifelong problems.
About 700,000 Americans suffer from the incurable illness, which can lead to inflammation, scarring and intestinal blockages that require surgery. Patients often take powerful steroids and immune-suppressing drugs to control symptoms.
But some doctors are experimenting with antibiotics as the main therapy. Their goal is to attack a bacterial infection that they think could be causing the disease.
Arianne Percy believes in the strategy.
The 26-year-old Deltona woman has been taking an antibiotic for six months. After dealing with abdominal pain since the age of 12, Percy said she is now symptom-free 90 percent of the time.
"I feel better than I have in years," Percy said. "I just hope it keeps working."
Her physician, Dr. Ira Shafran of Winter Park, has been studying potential bacterial causes of Crohn's for years. He thinks one culprit is a cousin to tuberculosis -- Mycobacterium avium paratuberculosis or MAP.
Shafran said an early, aggressive course of antibiotics could help many patients get better control of their symptoms. He has been testing antibiotic treatments in his own patients since the late 1990s, with varying success.
"While specific bacteria have never been identified as the only cause for Crohn's, we have enough scientific evidence . . . that bacteria are pivotal in the origin and persistence of this disease," Shafran said.
Inflames bowels
Crohn's disease -- named in 1932 after Dr. Burrill B. Crohn -- is a form of inflammatory bowel disease or IBD. Historically, doctors had thought of the illness as an autoimmune disorder.
Such conditions occur when the immune system attacks its own tissues -- in this case, the digestive tract. But many doctors now think Crohn's is not the body's attack on itself but a mistaken assault on bacteria that naturally live in the intestines. Numbering in the billions, these bacteria aid in food digestion and typically pose no harm.
For Crohn's patients, doctors speculate that the visitors provoke a chronic immune response that wreaks havoc on the body.
Sufferers can face abdominal cramping, diarrhea and the urgent need to use the bathroom. The condition can flare up periodically throughout a sufferer's lifetime.
"It's a disease of young people, [striking] at a time when they want to go to school, get married and start their careers," said Dr. Daniel Present, a Crohn's expert at the Mount Sinai School of Medicine in New York. "It can be very serious."
Some patients need to take potent immune-suppressant medication. Many also take antibiotics, though usually for short periods and in combination with other medicines.
Dr. Jonathan Braun from the University of California at Los Angeles said it's too early to know whether the drugs could play a bigger role in controlling the illness. Though many suspect Crohn's is linked to bacteria, he said there is no consensus on which specific types are to blame, which antibiotics are effective and how long a patient should take them.
"There's a lot of research that's left to be done on bacteria in the gut, and I think that as we understand those better, there will be new treatments," said Braun, chairman of the National Scientific Advisory Committee for the Crohn's & Colitis Foundation of America. "But for now, it's important to realize that while antibiotics may help some patients, none have shown to work on the majority of patients."
More research needed
In his Winter Park practice, Shafran estimates that about 100 of his patients are on long-term antibiotic therapy for Crohn's. They may remain on the drugs for years, with Shafran monitoring their progress and reducing the dosage as their symptoms subside.
He acknowledges the approach doesn't always work.
Another of his patients, Kira Banks, 25, of College Park has been through a course of antibiotics without success. She now takes an immune-suppressing drug that she credits with bringing her relief.
"This can be a very devastating disease," Banks said.
Shafran and his like-minded colleagues say more research is needed into the possible bacterial origins of Crohn's. For now, many have focused on Mycobacterium because the organism is known to cause a digestive disorder in cattle called Johne's disease.
But Shafran said MAP is not the sole answer to Crohn's, which is influenced by genetics and many as-yet unknown environmental triggers. He worries that drug companies, which typically don't make as much money on antibiotics, will not be interested in investigating their wider use in Crohn's sufferers.
And doctors are entrenched in their habits, turning to immune suppressants and other, more-potent drugs to attack the illness.
"A lot of people think, 'Why should I use a small-caliber weapon when I've got all these .44 Magnums lying around?' " Shafran said.
Dr. William Chamberlin from Texas also treats many of his Crohn's patients with antibiotics, often using generic versions that he says offer a low-cost treatment with fewer side effects.
"I cannot say it's a cure for patients, though some do remarkably well," said Chamberlin, an associate professor at Texas Tech University. "Others don't really do well at all."
Robyn Shelton can be reached at rshelton@orlandosentinel.com or 407-420-5487.
Dr. Ira Shafran sees Crohn's disease patient Scott Roy at his Winter Park office. Shafran is a gastroenterologist who is treating some Crohn's disease patients with antibiotics. (ROBERTO GONZALEZ, ORLANDO SENTINEL / November 21, 2007)
Doctors are trying a new strategy to treat Crohn's disease, an often-debilitating digestive condition that typically strikes in the teens or 20s and causes lifelong problems.
About 700,000 Americans suffer from the incurable illness, which can lead to inflammation, scarring and intestinal blockages that require surgery. Patients often take powerful steroids and immune-suppressing drugs to control symptoms.
But some doctors are experimenting with antibiotics as the main therapy. Their goal is to attack a bacterial infection that they think could be causing the disease.
Arianne Percy believes in the strategy.
The 26-year-old Deltona woman has been taking an antibiotic for six months. After dealing with abdominal pain since the age of 12, Percy said she is now symptom-free 90 percent of the time.
"I feel better than I have in years," Percy said. "I just hope it keeps working."
Her physician, Dr. Ira Shafran of Winter Park, has been studying potential bacterial causes of Crohn's for years. He thinks one culprit is a cousin to tuberculosis -- Mycobacterium avium paratuberculosis or MAP.
Shafran said an early, aggressive course of antibiotics could help many patients get better control of their symptoms. He has been testing antibiotic treatments in his own patients since the late 1990s, with varying success.
"While specific bacteria have never been identified as the only cause for Crohn's, we have enough scientific evidence . . . that bacteria are pivotal in the origin and persistence of this disease," Shafran said.
Inflames bowels
Crohn's disease -- named in 1932 after Dr. Burrill B. Crohn -- is a form of inflammatory bowel disease or IBD. Historically, doctors had thought of the illness as an autoimmune disorder.
Such conditions occur when the immune system attacks its own tissues -- in this case, the digestive tract. But many doctors now think Crohn's is not the body's attack on itself but a mistaken assault on bacteria that naturally live in the intestines. Numbering in the billions, these bacteria aid in food digestion and typically pose no harm.
For Crohn's patients, doctors speculate that the visitors provoke a chronic immune response that wreaks havoc on the body.
Sufferers can face abdominal cramping, diarrhea and the urgent need to use the bathroom. The condition can flare up periodically throughout a sufferer's lifetime.
"It's a disease of young people, [striking] at a time when they want to go to school, get married and start their careers," said Dr. Daniel Present, a Crohn's expert at the Mount Sinai School of Medicine in New York. "It can be very serious."
Some patients need to take potent immune-suppressant medication. Many also take antibiotics, though usually for short periods and in combination with other medicines.
Dr. Jonathan Braun from the University of California at Los Angeles said it's too early to know whether the drugs could play a bigger role in controlling the illness. Though many suspect Crohn's is linked to bacteria, he said there is no consensus on which specific types are to blame, which antibiotics are effective and how long a patient should take them.
"There's a lot of research that's left to be done on bacteria in the gut, and I think that as we understand those better, there will be new treatments," said Braun, chairman of the National Scientific Advisory Committee for the Crohn's & Colitis Foundation of America. "But for now, it's important to realize that while antibiotics may help some patients, none have shown to work on the majority of patients."
More research needed
In his Winter Park practice, Shafran estimates that about 100 of his patients are on long-term antibiotic therapy for Crohn's. They may remain on the drugs for years, with Shafran monitoring their progress and reducing the dosage as their symptoms subside.
He acknowledges the approach doesn't always work.
Another of his patients, Kira Banks, 25, of College Park has been through a course of antibiotics without success. She now takes an immune-suppressing drug that she credits with bringing her relief.
"This can be a very devastating disease," Banks said.
Shafran and his like-minded colleagues say more research is needed into the possible bacterial origins of Crohn's. For now, many have focused on Mycobacterium because the organism is known to cause a digestive disorder in cattle called Johne's disease.
But Shafran said MAP is not the sole answer to Crohn's, which is influenced by genetics and many as-yet unknown environmental triggers. He worries that drug companies, which typically don't make as much money on antibiotics, will not be interested in investigating their wider use in Crohn's sufferers.
And doctors are entrenched in their habits, turning to immune suppressants and other, more-potent drugs to attack the illness.
"A lot of people think, 'Why should I use a small-caliber weapon when I've got all these .44 Magnums lying around?' " Shafran said.
Dr. William Chamberlin from Texas also treats many of his Crohn's patients with antibiotics, often using generic versions that he says offer a low-cost treatment with fewer side effects.
"I cannot say it's a cure for patients, though some do remarkably well," said Chamberlin, an associate professor at Texas Tech University. "Others don't really do well at all."
Robyn Shelton can be reached at rshelton@orlandosentinel.com or 407-420-5487.
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